Michael Stearns, MD, CPC

The delay in the implementation of ICD-10-CM/PCS until Oct. 1, 2015, has given EHR users and vendors additional time to prepare their systems for the transition. It is doubtful that the majority of EHR systems and their users would have been able to make the transition seamlessly in 2014, and the delay has allowed time for a more orderly migration to ICD-10.  I will discuss some of the challenges associated with updating your EHR for compliance with ICD-10 and the importance of working with your vendor.

EHR applications are often built around the business logic of medicine. A core feature of many of these products is their ability to capture ICD, CPT, and HCPCS codes that can be used for claims submission and provide supporting documentation. However, the methods they use to store billing codes within the several hundred EHR systems that are in use today vary widely. More advanced systems have a central terminology model that uses a reference terminology such as SNOMED CT to store clinical concepts at more precise level than supported by ICD-9 and even ICD-10. An example of this would be a condition called Benign Rolandic Epilepsy. There is no corresponding specific code for this disorder in ICD-9 or ICD-10, but it is represented by SNOMED CT code 44145005. This offers advantage for clinical medicine, quality assessment, and clinical research, but it does not meet the billing requirement.  However, once information is captured and stored as SNOMED CT codes, it can be mapped to ICD-9 /ICD-10 codes required for claims submission and reimbursement. Since the core reference terminology does not need to change when a billing terminology update occurs, the EHR can allow user to seamlessly transition to ICD-10, ICD-11, or any other required terminology with minimal impact to the EHR user. In other words, terminology supporting clinical aspects of care are now managed by a code set designed for that purpose; but it still allows for the correct ICD codes to be submitted for claims purposes.

This is the preferred method for migrating to ICD-10 that has been, or is being, adopted by many EHR vendors. However, some systems may allow users to imbed ICD-9 and other billing codes within templates and other forms of locally created content. When this situation is present, imbedded ICD-9 codes will need to be updated to ICD-10 codes. This will require an understanding of ICD-10 billing requirements, as the supporting documentation in the template may need to be modified or expanded to address ICD-10 coding requirements. For example, a number of clinical conditions that were covered by one ICD-9 code now require multiple ICD-10-CM codes based on specific circumstances such as whether or not the patient is there for the initial, second, or third or subsequent visit.  

In summary, checking with your EHR vendor on how the transition is being managed would be a good investment of time. If a true central terminology model is in place, and no local modifications are needed to your clinical content, you may be in relatively good shape. If your EHR vendor requires that you update the codes and supporting documentation in your locally developed or modified clinical content, you have a few extra months to complete the task and to learn about the nuances of ICD-10.

a member of AHIMA’s Clinical Terminology and Classification Council. E-mail him 

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It's important to work with your EHR vendor to ensure ICD-10 compliance in 2015. Here are some of the challenges to address right away.